| NPI | 1619966108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OK 18832) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: OK 18832) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: OK 18832) | |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2008-10-24 |